men's exercise diet

dr. jordan metzl:it's a pleasure to be back again to speak toyou all about the medicine of exercise. and there were acouple things that made me psyched aboutcoming back to google. a, i take care ofa lot of you guys, and you're always justa pleasure to be around and to see. b, the ice cream truck.

i was like, dude, i lovethe ice cream truck. is that still here? audience: oh, yeah. dr. jordan metzl: all right. good. i was like, all right,definitely i'm coming, and i'm coming for the icecream truck, among other things. so what i'm here to do today isto talk about something which intuitively makesa lot of sense.

you guys are great ataddressing problems, and i want to talk toyou about a problem of the next decade, two decades. and i want you tothink about what i'm saying not only froma medical point of view but from a policy point of view. because i think what you've doneis given the world the ability to communicate in somany different ways here, and so i want youto put your brains

to the problem i'm goingto throw at you today, which is some of the problemswe're going to be facing and we're going to befacing the next 10, 20, 30 years going forward. a couple things just about me. i'm going to talk about themedicine of exercise today. i have a website here. i have a signup, if you'reinterested in getting our newsletters onpreventive health,

and i send outabout four a year. also i'm prettyactive in twitter and send out differentinformation on that. what i'm here to tellyou guys and what i'm going to be pushing todayis what we call get off your, i guess, couch, we'll say,get off your couch medicine. you guys are going to helpme get this message out on the importance of activityand exercise as a medicine. and it's an interestingkind of paradigm shift.

"the exercise cure" isa book which, i think, really it was an interestingway to pitch this. i did it with rodale. because the "home remedies" bookwas very successful and kind of, all right, i'm a runner,and i have a hurt knee, and i need to do theseexercises to fix my knee. this is a conceptual bookabout looking and changing the way people thinkabout exercise. i gave a lecture lastmonth at cornell med school

to the second year medstudents on exercise. now you'd think that thisbeing, as i'll go through, a very powerfuldrug people would hear about this all the time. in the 200-plus history ofcornell med school, that was the first lecture they'dever had on exercise ever. as i'll talk about, thewhole medical system is set up to treat disease,and it's very poorly set up to encourage wellness.

and so number oneis-- and i want to make sure that nobodyin your guys' world is this person who is basicallyso focused on whatever it is they're doingthey're not moving. and the concept here isthat across the spectrum of the human condition there'sno more powerful, potent, and effective medicinethan exercise. and so i'm just goingto go through relatively quickly some information.

this study published thisyear just a couple months ago in a journal called"circulation" from the americanheart association, looking at men greaterthan 45 years of age, a prospective study, whichis the best kind in medicine, looking at the effects of heartfailure and what causes that. and not surprisingly,sitting around on your butt all the time and notmoving correlates to a much higher incidenceof heart failure.

so it's not good for your heart,and this is the number one killer in the united states. now the concept of movementfor activity and for health and for just a betterbalanced life is nothing new. the ancient greeksand the ancient romans knew that to be sound in mindand body those things work together. so the concept of dumb jock,it's not really true, in fact. in fact, even from the highschool and middle school

levels, people who areactive and involved in sports have everything from higherself-esteem to higher health profiles as they go intoadolescence and young adult. so basically activity issomething that starts young. we do a lot of preventivestrengthening classes with kids, and getting kidsinterested and involved in athletics at ayoung age it correlates to a number of goodthings as they go forward. so there's a big studypublished last year

in the "journal of americanmedical association," called "jama," and inthis study they looked at the anatomy of thehealth care system. now a couple things. number one, we've morethan doubled the money we're spending asa product of gdp. we spend about 18% of our gdp,about $2.7 to $2.8 trillion a year. just to put thatin context, that's

more than the gdp of mostevery country in the world, so it's a lot of money we'respending on health care. government funding hasincreased to about 42% of health care costs,about $325 billion of which are spent onprescription medications. and surprisinglypeople think that it's old people that cost the systemmoney, but it's really not. it's overweightpeople, inactive people cost the system byfar the most money.

and it's also young people. so 85% of the medicalcosts are under 65, and a large majorityof that, about 60%, are related to the effectsof inactivity, obesity, heart disease, diabetes, etcetera, so 65% of that spending costs. so basically, ourcountry needs to move. and as we'll get talkingabout technology, you guys have beenhelpful in starting

to get different apps andthings that encourage and track movement. i want to bring thoseinto the discussion on encouragingmovement as policy. so we have thishealth care system which throws huge amounts ofmoney at disease treatment. the concept is that basicallythe worse the medical problem the more the system pays. so if you're somebodythat goes into see

or your parents go seesomebody for their heart exam and the doctor says, all right,you should exercise and eat well, that's anormal office visit. but if you're put onmedication, then somebody in some drug companysomewhere in new jersey is going to make a profit. if you have anechocardiogram or an ekg or a catheterization, themore things that are done, the more the system isreimbursed, all the way up

to open heart surgery. and so the system is basicallyfinancially incentivizing disease, and it's for everydisease, every problem. and wellness, whichmakes the most sense that we should be thinkingabout encouraging, really isn't incentivizedin the same way disease is. and so we basicallywait until it's broken. and so the concepti've been pushing is getting america to go.

now this is the united stateson the far left-hand side the graph here. every other western countryaveraged out is in the red. so we're spending morethan double every country in the world on healthcare expenditure. so with that, iwould think we would have the healthiest countryin the world, right? how about 28th inlife expectancy? so we're spending morethan double everybody,

we're ranked 28thin life expectancy, and we're just throwingmoney at this problem. and even all these differentdiscussions about affordable care, et cetera, are a lot aboutreducing spending in some way, but they're notabout the main issue, in my opinion, which ispreventing disease, which is what we're reallynot focusing on. this is the unitedstates in 1985. states reporting less than10% obesity are in light blue,

10% to 15% are inthe darker blue. and let's look what happened,'86, '87, '88, '89, '90, '91-- now 15% to 19%obesity-- '92, '93, '94, '95, '96, '97-- nowgreater than 20% obesity-- '98, '99, 2000, 2001-- greaterthan 25% obesity-- 2002, 2003, 2004, 2005--greater than 30% obesity-- 2006,2007, 2008, 2009. so basically, if you want tobe skinny move to colorado is the answer here.

but we have thiskind of growing issue of the cost of inactivityin our society. and as much as i love all thecomputer-based everything, it basically is another waywhere people sit at home and do whatever. so getting people up and movingis a huge piece, i think, of the equation offixing the problem. so i'm going to talkto you guys about what you can do individually,what you can do as a company,

and what i think we can startthinking about as a society to try and deal with some ofthese issues as we go forth. so what you can do as anindividual is find something you like to do. if you like to bike in agroup, bike in a group. if you like to go run ina group, run in a group. if you're somebodythat says, listen, i'm so stressed outat my place and i want to go run bymyself, that's fine too.

whatever it is thatwill motivate you, that's what you got to do. so number one isfinding a way to do it. and i'm going to talk aboutnew york city is a great place to do that, because wehave a great opportunity to increase what's calledour neat profiles here. now i think nothingis as helpful as some of the different people i seein my life and take care of. i met a guy yesterdaywho i'd seen about three

months before who'd had reallybad back pain and knee pain, and he'd gotten opinionsabout getting surgery on different stuff. and i said, listen, you aregetting a lot of this problem because you're justcompletely inactive. and if you want to seesomebody's torn meniscus, get an mri. if you want to see theirherniated disc, get an mri. as technology has improved, thequality of pictures, about half

of you in this room have a tornmeniscus or a herniated disc in your back that youdon't even know about and i don't care about becauseit's not bothering you. but the problem is if you startgetting tests things start showing up, and thenpeople get things done based on those findings,and it's not good for people. this guy, we just got himworking on some strengthening and exercise stuff, andi saw him yesterday. he's doing great.

i think that puts a lot of thesethings in a better context. because somebody like that thatshows up at a psychiatrist's office is probably goingto put on some kind of antidepressant medication,in a cardiologist's office some kind of bloodpressure medication or cholesterol-loweringmedication. and there's a lot of medicines. we live in this society whereif you're having sleep problems your immediate thought is openthe window and that butterfly

is going to fly andland on your head, and you're going have the bestnight's sleep of your life. or if you're havingerectile dysfunction, you just take this medicine. you can throw thefootball through the tire, and life is greatand life is perfect. the problem is thesemedicines cost a lot of money, they have a lot of sideeffects, and they're often not the bestfirst-line treatment.

so getting doctors andhealth care professionals to start thinking aboutprescribing exercise is a big part of the missionof what i'm after with this. and it's interesting. as i mentioned, there'snot a lot of movement or there hasn't beena lot of movement traditionally in thatdirection, despite the fact that we had great evidenceon the role of exercise for a number ofdifferent problems.

so what i've tried to doin "exercise cure" is start with the brain and go downand look at, all right, what's the best study fordepression and exercise? there's a big studydone in norway where they took one group ofpeople in a prospective study and they looked at theirsymptoms of mild to moderate depression withexercise versus drugs, and the exerciseguys did better. so things like anxiety, sleepproblems, self-esteem, memory--

exercise is the onlydrug which works for alzheimer's anddementia, the only drug. despite the billionsof dollars that have been put towards research,it's the only drug that works. so i think there's alot of information that needs to get out onthis, and part of that definitely starts with thehealth care profession, so trying to get physicians andnurses and nurse practitioners as part of whatthey do and trying

to get wellness programs tomove outside of the realm of companies, which are great,and into the realm of insurance companies. incentivizing, which i'lltalk about in a second, is something which is part ofthe policy discussion, which i think really definitelyneeds to happen. unfortunately, lessthan a third of doctors talk to their patients aboutexercise, and those who do don't really know how to do it.

so in the second halfof "exercise cure," i've talked about how toset up fitness programs at home for yourselves. and that's important fordocs, because they just say exercise a half hour a day. well, all right,that sounds good. what do i do? how do i do that? that's been a neatspace with some

of the different great newapps about setting up programs, by the way, too, which i love,and that's exciting as well. nutrition. nutrition is part of the deal. so i have in both mybooks some information at the back on nutrition. i'm more about exercise. i think the data on exerciseis far more compelling than it is straighton nutrition.

so i think what you eatmakes a difference for sure, but after thistalk you are going to see me hit the icecream cart for sure. and i'm going to do that becausei worked out this morning and i like ice cream. i'm an absolutist whenit comes exercise. i'm not an absolutistwhen it comes to food. i feel like you can driveyourself nuts with food, and many people do.

and i think to me thehealth benefits, by the way, of exercise trump mildto moderate obesity. i'd much rather you be mildto moderately overweight and exercising everyday than super skinny and not exercising at all. so the concept of what drugworks for everything from some of the brain issuesi talked about, reduction in the frequencyof the common cold, reduction of blood pressure,reduction of cholesterol

levels, treatment of diabetes,treatment and prevention of osteoarthritisand osteoporosis, even certain types ofcancer, particularly colon cancer, which is about40% less common in people who exercise four to fivetimes a week is exercise. so this is definitelya medicine. and you can thinkabout it in everything from the kind oflife people live to the duration oflife people live.

every hour you put in ofexercise-- and because you're exercising, you live longer--correlates to about five and a half hoursof life expectancy if you're going vigorous. by the way, i'm a bigfan of vigorous activity. so if you have ahalf hour-- and i talk about the differentzones of exertion. zone one is what i'm inright now, just talking, and you could exercise and walk.

zone two is when it's alittle bit uncomfortable, and zone three is whenyou're huffing and puffing, like sunday you'll bein zone three some. you'll be in zonethree some sunday. so i want people tobe for their workouts about 25% in zone three, 25% inzone two and 50% in zone one. so if you're just going fora slow jog, that's great, or a slow walk, that's fine. but try and push your zonesup for at least a quarter

of every workout up tozone three, if you can. not only does it helpprofuse your organs, like your brain et cetera,it's just generally much better for your heartmuscle, which is also a muscle that needsto be exercised. and since women live longer,exercise has very favorable-- but again, it's theintensity, which is a big piece of this, in termsof looking at what that means. this was a big study thatwas published this past year

in the "british medicaljournal" and got a lot of play in the media. it actually came out of theweek before my book came out in december, whichi didn't even know. but i was like, wow,that was good luck. and what these guysdid is they looked at basically 16 meta-analyses,four on exercise and 12 on drug trials,looking at four conditions, prevention of coronaryartery disease,

prevention of diabetes,rehabilitation of stroke, and treatment of heart failure. and they compared exerciseto drugs, all right? straight comparisons,exercise to drugs. what they found was in aboutalmost 400,000 participants there was no differencein exercise versus drug groups in the prevention ofheart disease and diabetes. what that means is thatall these people that go to their doctor,all right, go

take crestor, lipitor, whateverit is as part of what you're doing in a preventiveway, exercise was just as effective with muchless cost and much less side effect. i see every week 200, 300people in my office coming in with lipitor orcrestor-induced myalgia. their muscles are super sore. their joints get achybecause of these medicines. there is no such thingas a perfectly safe drug.

even the tylenol youget at cvs or the advil you get at the bodega aroundthe corner has a side effect. now normally thatdoesn't cause a problem, but there's no such thingas a perfectly safe drug. the only drug, basically, withno side effects is this one. and it was moreeffective than medicine in the treatment of strokebut was less effective than drugs in thetreatment of heart failure. so i'm not antiwestern medicine.

i'm pro getting doctorsand health professionals to start thinking about thisas part of the paradigm of what they do when they see people. now part of what ido is to keep people from doing stupid things. so if you show up in myoffice and you're like, i'm on the google runningteam, which is a great group. i'm going to run the marathon,but it's two months away, and i've not done anything.

i'm like, dude, that'snot a very good idea. so part of what i dois encouraging people to do smart thingsin a smart way. i see some of you recognizeyourselves in that comment. so looking at thecdc here, the cdc did a big all-causemorbidity study in 2000 looking at what getspeople sick and ill. and people think, oh,it's just my genetics. genetics are about 20%of their conclusion.

the biggest factor was basicallyexercise, smoking, and diet, which are the big factors whichseem to affect how people-- i'm just going to say it right now. i'm a big fan offormer mayor bloomberg. you look at some ofthe things he did, including getting smoking outof a lot of places in new york city, getting bikelanes in place for people to startmoving around, starting to talkabout restricting

different kinds offoods, big sugary foods, as part of the thing,i think that makes a ton of sense fromthis equation of what are some things tostart to think about, particularly becauseof the following thing. if you were inactive in your 60sin this red line on the left, you have a higherchance of dying than if you're veryactive in your mid 80s. pretty impressive, and soif you think about it, also

for the treatmentof disease as well. so basically the importantthing about all this is that we wantpeople to be active, and we want to in ourhealth care system keep them out ofthis kind of end zone where they're havinga really tough time. we want to keep them activeuntil the last-- i had an 82-year-old lady runthe marathon this year, and i think goal settingis a big piece of that

as well as some of the stuffto think about in terms of what you want to do. and the goal is to basicallydie young as late as possible. i made the comment beforeabout fitness versus fatness. and again, i would much ratheryou be overweight and active than skinny and inactive. the benefits ofhealth and exercise kick in not with yourbody shape or size. it has to do withwhat you're doing.

and so it's better be fat andfit than skinny and unfit. low levels of fitness isa much bigger risk factor than it is activity. so it's what you're doingthat becomes the key thing. and you're going to be hearinga lot more of this coming up in the next five years or so,something called interleukin 6. so interleukins basicallytell cells what to do. they're kind of likethe quarterbacks of telling differentcells what to do.

interleukin 6 ismade in two places. it's made in your muscles,and it's made in your fats. if you're sitting aroundnot doing anything, your fat makes il-6, whichis pro-inflammatory so pretty much every chronic diseasewe see, asthma, arthritis, you name it, mostevery chronic disease is affected by levels ofcirculating inflammation. and when you're making this fatil-6, it's a pro-inflammatory. so you basically getthese increased levels

of different markers ofgeneral body inflammation. when il-6 is made by muscle, ithas the exact opposite effect. it basically is completelyanti-inflammatory. so the idea here is thatchronic disease is basically prevented and treated withhigher circulating il-6 from muscle. and so we're just discoveringthis and applying this. that's why things like coloncancer or things that might not make a lot of sense-- why wouldi exercise and that would help

that?-- i think there's a lot ofchronic disease models that are to be affected by this conceptof il-6 as we go forth. you'll hear more aboutthis in the years to come. but it's a superinteresting, i think, field that we'rejust recognizing the benefits of thisbeyond the scope of it just makes me feel good. all right. so by this point of my talk,you're like, all right, dude,

i got it. exercise is good for me. that's why i'm here. that's why i came to hearyou in the first place. so now the question is, howdo i put this into my life? i get it. i should do it. how do i do it,and how do i make my parents, who arehome in indiana, do it?

because i'm doing it here innew york city, but they're home, and they're sitting aroundwatching tv every night. how do they do it? and so that's where we'regoing to talk about next. so basically what i did in thesecond half of "exercise cure" is to divide up fitness levelsinto bronze, silver, and gold, meaning inactive, moderatelyactive, and very active. and here are some formulasfor all those guys. so my bronze level guys arepeople who don't do anything.

show of hands. who here has a fuelbeltor a jawbone or something like that on theirwrist or person? one, two, three, four,five, six of you guys. i think that'sbeen really great. i think it helpskeep people honest. i don't know if you'vehad that experience, but all of a suddenyou're like all right, i took this number of stepstoday, i got to do more,

or i took this number ofsteps today, i got to do more. and i think that's been reallygreat for my bronze guys in trying to give you agoal and a social network, that, listen, all right,my sister in toledo she took this amount of steps. i want to keep up with her. and that's beenvery helpful, and i think we'll see moreof that as we go forth. i want you to thinkabout something

which you guys dogreat at google. you guys still have thescooters here and everything? so what you guysdo here at google is you're activelyincreasing your neat profile. what's that? non exercise activethermogenesis, or just burning caloriesfrom cruising around. every time youscooter up and down, go up and down thepole-- you guys got

that pole thing,the slide thing? all right, cool-- youdo that kind of stuff, you're increasingyour neat profile. and as you do that, you're justbasically burning calories. what that does is thinkabout that first slide i showed you from thatjournal "circulation." you're reducing yourrisk of chronic disease. i think of it this way. basically, we had thishuge public health campaign

against smoking, becausesmoking was correlated to all kinds of things,heart disease, diabetes, certain types of cancer. sitting is a new smoking. all right? straight up, sittingis a new smoking. inactivity and the healthproblems from inactivity are almost identicalto the health problems from smoking,which is why i want

to get going on publichealth campaigns to encourage activitymuch in the way we used those same things to getrid of many of the smokers we used to see, because theprofiles are almost identical. silver workouters,we have to start thinking about increasingyour kinetic chain. and then golds arethe guys who are going to come toclass on sunday, and i'll talk aboutsome of the stuff

you can do onlineon your own at home to start buildingyour gold profile. so what's ourcurrent system doing? some health carecompanies, some companies give you a discountif you join a gym. that's great. but all right, soyou join a gym. does that meanyou're going to go? i don't know.

the truth is less than 5%of americans are active. there was a big study publishedof 11 different studies 2012, 2013. motivation camethrough incentives. if we incentivize peopleto move, they moved. this is the best study i'mgoing to show you in this talk. this guy published in "jama,"and he's got a dual appointment at the universityof pennsylvania. he's at wharton andat the medical school.

and his whole thing islooking at financial models to incentivize behavior. and he took 56 guys whowere very overweight. now they were betweenthe ages of 40 and 60. the truth is if you wantto get either gender to change whatthey're doing, try getting a guy tochange his behavior? good luck. so baseline, it's tough to getguys to change their behavior.

fair? fair. now in that we hadthese guys that had these reallyunhealthy health care behaviors for a long time. they were very sedentary. and what he did was he set up amodel where basically everybody got the same intakeinformation, diet and exercise. now in that, one group theywere weighed every week

for 16 weeks, andthat's all they got. one group, he said, listen,if you lose a pound a week for 16 weeks, we're goingto give you $5 a week. and one group said,you're going to come in, we're going to weighyou once a week, and you get a scratch-off,like a lottery. and if you basically areat your target weight, if you lost a pounda week, then you win what's underneath the thing.

it was everythingfrom $5 to $50. so some weeks you do good,and some weeks you do bad. at the end of four months, theguys that got the information but didn't getanything else, they were just weighed,exactly the same weight. both the financial models loston average about 17 pounds, and everybody madetheir target goal. now the average diabeticwho has diabetes because they're overweight andtakes insulin cost about $350

per month on medicine. these guys werepaid at an average of $250 over a four-monthperiod of time. it doesn't take much money. it just takes a littleincentive structure. so different companies aredoing different things, everything from using-- some of you have fitbits. if you join humanainsurance, they

have this vitality programwhere you can sign up for the vitality programand you get a fitbit. then they calculate what'scalled your vitality score and your vitality age. so you're 35, and yourhealth care behavior is such that you may be only31, or you may be 40. and they calculatehow many steps you need per day and per week. and if you meetyour target goals,

you pay a little bit less inyour health insurance premium. because why should youpay more than somebody else who's really inactive? it doesn't make any sense. plus it'll incentivizeyou to do more. so there's a lot we're goingto be seeing in this space to encourage peopleto do the right thing. and we do it already. why do people buy houses?

and why do people doall kinds of things? we incentivize marriageand having kids and going intodebt in some ways. so our systemalready incentivizes all these behaviors. we're spending so muchmoney on this problem, we should be incentivizingactivity and wellness. and so that's i think that is. so with you, your baseline notefor you and for your parents

is i need 150 minutesa week of exercise. everything beyond that's gravy. 30 minutes a day, 150 minutesa week, that's what we need. and so let's talkabout our bronze guys. our bronze guys are guysthat are sitting around. we want them to increasetheir neat profile, meaning we wantthem to just burn more caloriesthroughout the day. as we get to oursilvers, we start

thinking about nowincreasing their strength and their cardio. so as i get to my silvers, istart thinking about increasing what's called yourkinetic chain. if you're activehere or if you've been to see me at some pointor have been to my classes, you hopefully wokeup this morning and said i lovemy kinetic chain. if you didn't,think about it now.

i love my kinetic chain. that sounds good, dude, butwhat's the kinetic chain? the kinetic chain ishow all the muscles are connected in thebody, tip to toe. and for a kinetic chain towork, it needs to be flexible and it needs to be strong. so if you come in to see me withan achy knee or an achy shin or an achy hamstring, whati'm going to tell you is-- or a herniated disc in yourback or whatever it is--

i can't fix your anatomy. if you have some arthritisin your knee, you do. if you have aherniated disc, you do. but if you make yourkinetic chain more effective through strengthtraining and flexibility, those things are goingto feel a ton better. so number one,flexibility, huge fan. who here owns a foam roller? so hopefully not only do youown it but you're using it,

which is the otherpart about having it. sometimes people justhave it, and it's like a clothesstand in the corner. and so what i say is usingthis roller is hugely valuable. in both this book and inthe "home remedies" book, i have a full foamroller workout to do, and you can kind ofsee that in there, what to do with yourroller so it's not just sitting in the corner.

i say every day. but realistically, three timesa week for about 15 minutes will really helpyour flexibility. the other piece is strength. so these functional strengthtraining classes are a blast. if your i-whateverdevice is close to you, if you just yank it out andtext in the number 22828 and put in the oneword ironstrength, you will automaticallybe signed up

to be on our strengthtraining list. and by that you'll getemails every couple weeks talking about ourdifferent classes. i'll leave this upfor a sec, if anybody wants to register for that. and it will automaticallysign you up, and you'll be partof our class list. these classes are always free. every fourth class,we do a fundraiser

for different nonprofit. so for example,this sunday we're doing a fundraiser fora great nonprofit called girls on the run, whichtakes at-risk girls and teaches them aboutrunning and running programs to help them buildself-esteem and good health behaviors. so we try and do a differentnonprofit every couple months. but they're a ton of fun.

we do them in the wintermostly indoors at equinox at rock center. in the summer, we dothem all over the place. i usually do a couple down hereon pier 25 right near you guys, basically across the street,after work in the summer. we're going to one thissummer on governors island, which will be a lot of fun. and i'm going to throwthis out there right now, but i definitelywould be psyched

if you guys would be psychedi would come down here one morning and lead a 7:00am on the terrace workout and kick some google butt,if you guys want to do that. if there's interest,yes, we'll do that. [audience applauding] dr. jordan metzl: so we'llset it up this summer. we'll try an ironstrengthworkout this summer down here. if you can pop open the icecream truck after the workout, that'd be great.

but that'd be great. so these are really fun ways. if you live wherever andyou want to try this online, if you go torunnersworld.com just put in my name orironstrength, you'll find this streaming video. it's free, and you cantry this stuff at home. now finally we're at our gold. those are the advanced guys.

so those are the guys whoare doing plyometrics. and a plyometric is avery rapid elongation, contraction, cycle the muscle. ironstrength is a veryplyometric-based workout. and i think you can reallytrain that stuff at home. that's what ourclass is all about. and basically, people havedifferent distributions of slow and fast switch fibersin their genetic anatomy. that's why some people arenaturally faster than others.

but even within that, youcan do a lot with yourself with plyometric-basedstrengthening. you can really make you a muchbetter athletic version of you with that. so in conclusion,i would just say that i hope that this messageof exercise as medicine is one that resonates. and i look forward to seeingyou at one of my classes soon. maybe i'll see you here whenwe do a boot camp up here.

and i hope you think about thismessage and kind of push it forth in whatever way you have. to me, this is the fundamental-- oh, that's fine. that's the last one. that's this one. but just resources ihope help keep people thinking about this dialogue ofgetting people out and moving and active.

because i wouldmuch rather think about preventing diseaserather than spending all these billionsof dollars paying for the treatment of disease. i'm happy to answer anyquestions in the room. yeah. audience: thanksso much for coming. dr. jordan metzl: sure. audience: it's really fun.

so you talked a little bit aboutneat profiles and the things google does tohelp us raise them. one of the things wehave are standing desks. and when i try to stand all daylong, it's really exhausting. so what would you put as abenchmark for using that? and i have a secondquestion, which is in your book i wasflipping through it and you said something aboutexercising seven days a week, which is a lot.

i usually find that by daysix i'm pretty tired and sore. so what sort ofexercises would you recommend doing overthose seven days so that we're still energizedto keep going on day eight? dr. jordan metzl: great. so two good questions. i'll answer thesecond one first. exercising seven days aweek i'm a big fan of, but it doesn't mean you have todo the same intensity or thing

or even close. so whatever it is, if it'sgentle stretching, a swim, a yoga class, or maybe nothing,but i think basically doing something daily just helps fora number of different reasons. obviously you don'tneed the reinforcement because your lifestyle behaviorsare already deeply entrenched with exercise, but i thinkdoing something every day, physiologically, mentally ismost helpful for most people. but it doesn't have to be thesame intensity, for sure not.

incidentally, we did ouroffice outing last night. we did a hot yogaclass last night. i was like, dude, we're notdoing this again, but anyway. [audience laughing] dr. jordan metzl:but it was good. now it was pretty good. i'm kidding. so that was good. and then thestanding desk issue,

i love those thingsif you like them. now much like trainingfor a marathon, your marathon wouldn'tbe your first race. and so doing a full dayof standing probably shouldn't be your firstexposure to a standing desk. so to go from a seated deskto a full standing desk is like going fromrunning a 5k to running the marathon without takingthe 10k and half marathon steps in between.

so i think trying things,like at our office we have those littleball seats where people sit on a ball as an intermediarystep to getting to a standing desk or doing lots of planksand building up to it, but i wouldn't go whole hog. i would try and buildup to it over time and see how that goes,if that's a possibility. but if it's stillbugging you, i think building your core strengththrough a lot of planks

and stuff will help you beable to do it for longer. and i like those desk,if you like them. there's also atreadmill desk too. do you guys have those here? audience: yeah, we do. dr. jordan metzl:that's pretty cool. audience: hi. thank you. i had a quick question.

so you talked about150 minutes a week. unfortunately, i'm a littlebit of a weekend warrior, and i do a competitiverace class on a spin bike where they captureyour heart rate. and i find that myheart rate is often for prolonged periods of timeabove the 100%, like well into the red. and then it'simpossible to recover for the rest of the day.

is it because you should notbe exercising at that intensity for so long? or are there otherthings that you can do so-- i can sustainit, but i'm a disaster. dr. jordan metzl: it's agreat physiology question. so what you'retelling me, though you don't know you'retelling me, is you're finding your lactate threshold. so let me give you two terms.

one is called vo2 max. and so vo2 max is themaximum amount of oxygen you can take out of your blood. and so that's whyif you're at a race and there's some womanahead of you and you're like i want to catch her buti just can't catch her, and every race she'sahead of you by whatever, she physiologically probablyhas a better vo2 max. basically, the more oxygenyou take in, the more atp you

can use, the betteryour muscle will work. and that tends to begenetic more than anything, which is what i always say. you can marry whoeveryou want, but if you want to have fast progeny youshould reproduce with somebody who's got a high vo2 maxis my general comment. now that beingsaid-- that's a joke. all right-- the key thatyou're not recognizing is what's called yourlactate threshold.

so lactate thresholdis the level where lactic acid builds upand starts to basically make muscles acidic and not workvery well and unpleasant to do stuff. audience: yeah. dr. jordan metzl: lactatethreshold is hugely trainable. vo2 max is not. lactate threshold is. so you can go forlonger periods of time

and not feel like you justgot shot the rest of the day if you train yourlactate threshold. and that is intervaltraining, so the stuff like in ironstrength. you should do myworkout on your phone twice a week for ahalf hour at home. if you start meeting ourgood friend lord admiral burpee from the british navy-- dr. jordan metzl: burpeesare great because they

start buildingcardiovascular strength. interval training pushesthat lactate threshold, and then your weekendwon't kill you as bad. so there's a lot ofways to make that better so you don'thave to stop doing that. audience: ok. dr. jordan metzl: all right? audience: thank you. audience: all right.

so it's not amarathon, but emily knows i'm going to thishiking retreat in a month. dr. jordan metzl: cool. audience: and ihaven't worked out regularly in about a year forvarious reasons, mostly just new york. so i've got a month to getin shape to hike every day up to 17 miles in the last daywith two yoga classes a day plus some sort of barre class.

what should i do-- as apretty not even bronze. i say i'm like a copper--in the next four weeks? dr. jordan metzl: well, firstof all come get my card. no, i'm kidding. no. so you have a month,and your month needs to focus onbuilding strength. are you an established hiker,or are you a new hiker? audience: i used to be.

i used to live innorthern california. dr. jordan metzl: got ya. audience: so it'sbeen hard here. it can be done. fair enough. so you have to thinkabout, number one, building some strength. so you have a month. you can definitely make greatstrength gains in a month.

do that some of the onlinestrengthening stuff. it would be great for you. start building somebaseline strength. that will help. you have a foam roller? audience: yes. dr. jordan metzl: ok. so if you have the small one,you can bring it to california. is that where you're hiking?

audience: i am, yeah. dr. jordan metzl: so bringyour roller with you. because every daywhen you get back, i want you to makesure you roll. so building strength andincreasing your flexibility will help your kineticchain work better. and then there's somesport-specific things. so we don't have a lot of greathiking super close to here, but we do prettyeasy to get away to.

but we've got a lot of stairs. so we have a lot of buildingswith a lot of big stairs. and that can really helpfor hikers, particularly mountain climbersthat want to build those particular glutemuscles and all that. so a combinationof stair climbing, plyometric strengtheningonline, rolling, that will definitelyhelp make a big dent. and you can go from copper--we can get you up to silver,

i bet, in a month. audience: ok, great. audience: hi, dr. metzl. dr. jordan metzl: hi. audience: so talking aboutthe bronze, cop-- no, silver-- dr. jordan metzl: yeah. i like copper, though. that was good. audience: --levels,and this is kind

of a running-specific question. with regard to your easy days,your normal running days, however long you run, justat a moderate to easy effort, where does that fall inyour mind in that standing? and you mentioned howwith each day, i guess, you want to hit at leastsilver or gold for 25% of that portion. so would that involverunning your easy runs with a portion of it beingpicked up, et cetera?

dr. jordan metzl:that's a good question. so it kind of dependson what level you're at. but there is such a thingas just a straight recovery day, recovery run, andthose i think you just do a straight recovery runindependent of the other stuff. i'm kind of speaking inthe workout structure more just when you're actuallydoing a pretty active heart-- if it's just a slight recoverything and how you're training, and obviously you're moreadvanced to ask that question,

i think your recoveryrun should still just be recovery if you'redoing that kind of stuff. but i don't love-- recoveryrun isn't for everybody. i think recovery swimor recovery yoga class or whatever is great too. so i wouldn't be fully lockedinto the straight recovery. and then the othercomment i would make for you is runners aremy most delinquent strength trainers, in general.

i don't know if you fallin that category or not, but i hope not. audience: i try not to. dr. jordan metzl: what? dr. jordan metzl: ok, good. but runners tend tothink, oh, i'm running, so i don't need to--in fact, since you're running you needto really do more to build that kineticchain strength.

sure. audience: so i actuallyhad two questions. the first one is i'm probablya little atypical for google, as i probably havea few more miles on me than the average googler. and with that comesassorted injuries that you accumulate over time. so i was just wonderingin terms of just as a general matter instrength conditioning,

do you think it's advisable tosort of target the areas where you've had problems in the past? or is it just more of anoverall conditioning thing? and my second question is youdidn't talk much about sleep. and i'm just wondering how sleepfigures as a dynamic, because-- thanks. two good questions. audience: --sometimes the choiceis either exercise or sleep. dr. jordan metzl:two great questions.

the workout stuff italk about and tech is all about what's calledkinetic chain strengthening, so a chain is only asstrong as its weakness. so if you have a little bitof arthritis in your knee, by making thatwhole chain stronger it puts less load on the knee. there also are someinjury-specific things. i'm actually workingon my next book now with "runner's world,"which is another rodale thing

and then a whole seriesof 20 of these videos called "inside thedoctor's office" where you can clickon your iphone and watch the video incombination with the paperback. it's to be really cool, i think. in that i have awhole thing on sleep and the importance of sleep. and it's a fine line betweenam i sleeping enough for me and do i skip theworkout and sleep.

and it can be aday-to-day decision, and i don't have anexact number for you. it depends on how you'refeeling and what you've done. so i think, basically, you gotto listen to your own body. and i would rather sleepthan do a bad workout, but i tend to function a lotbetter if i do something. so i think it's avery individual thing. there's not an absolute numberi can give you for that. but it's certainly somethingto think about, and definitely

in terms of performance as well. i'm happy to sign anybooks you guys have. thank you so much forhaving me, and i'll see you see you soon in class. bye bye.